Health Education Thames Valley - Specialty Training Programme in Genitourinary Medicine

HEALTH EDUCATION THAMES VALLEY - SPECIALTY TRAINING PROGRAMME IN GENITOURINARY MEDICINE

About Health Education Thames Valley

We are the Local Education and Training Board (LETB) for Thames Valley covering Berkshire, Buckinghamshire and Oxfordshire. Our vision is to ensure the delivery of effective workforce planning and excellent education and training to develop a highly capable, flexible and motivated workforce that delivers improvements in health for the population of Thames Valley. Thames Valley LETB is responsible for the training of around 2000 Foundation and Specialty trainees.

Health Education Thames Valley is a relatively small organisation with a defined geographical area which serves as a single unit of application. In the majority of cases successful candidates will be asked to preference their choice of location for either one or two years. Some programmes will require successful candidates to indicate a location and specialty. Future placements will usually be based on individual training and educational needs. Please note that applications are to the Health Education Thames Valley as a whole. This may mean that you may be allocated to any geographic location within the deanery depending on training needs.

The Genitourinary Medicine Training Programme

The Genitourinary Medicine training programme is a 4 year programme, starting at ST3. During this time, the trainee's work will be monitored for satisfactory progress and subject to annual reviews in the form of ARCPs. Progression on the programme will be dependent upon these reviews.

The posts on this rotation have been approved for Specialist Training by the Royal College of Physicians. The posts attract National Training Numbers and provide training towards a Certificate of Completion of Training (CCT).

The Postgraduate Dean has confirmed that this post has the necessary educational and staffing approvals.

The programme is based in several different Trusts throughout Health Education Thames Valley so trainees may find themselves employed by any of the following Trusts and placed in any of the following hospitals:

Trust / Hospitals and Locations
Oxford University Hospitals NHS Foundation Trust - Oxford / Churchill Hospital, Oxford

The Orchard Health Centre, Banbury
There are also satellite clinics in Didcot, Witney, Bicester, Wantage, Abingdon, Kidlington and east Oxford
The Garden Clinic (NHS Berkshire East) – Slough / Upton Hospital, Slough

Skimped Hill Surgery, Bracknell

St Marks’ Hospital, Maidenhead

Florey and Contraceptive Service (Royal Berkshire NHS Foundation Trust) – Reading / Royal Berkshire Hospital, Reading

West Berkshire Community Hospital, Newbury

Rotation Information

Rotations may at times change in response to clinical need from the Trusts. Expected rotation arrangements for this programme are

It is envisaged that trainees will rotate through all 3 centres e.g.

Year 1 – Oxford; Year 2 – Slough; Year 3 – Reading; Year 4 –Oxford

The exact rotation will be planned on an individual basis with the trainee and the Specialty Training Committee.

The overall objectives of the training schemes are to produce competent, knowledgeable and highly motivated genitourinary physicians by offering a wide experience in all areas of the specialty as well as appropriate exposure to research, audit and management.

The training programme is over four years. Competency will be acquired in GUM, HIV, dermatology, gynaecology, microbiology as relevant to GUM, contraception, management, public health and epidemiology. Some specialist experience will be gained by attachments to other services.

Out patient HIV experience will be gained through training at all centres on the rotation. In addition trainees will be encouraged to spend up to 3 months in a large HIV patient centre in the latter part of their training to consolidate this experience.Experience in an integrated sexual health service and contraceptive training will be provided by rotation to the Garden Clinic, Slough and in Oxford.

Trust Information

Oxford

Oxfordshire Sexual Health Service is the largest department in the Thames Valley, seeing some 30,000 outpatient attendances per annum for GUM and 15,000 for contraception. The service is delivered from the Churchill Hospital in Oxford and also from the Orchard Health Centre in Banbury on a full time basis. Both sites offer a full service for the management of sexually transmitted infections, including HIV infection, other genital conditions, and the full range of contraception services. There is a mix of appointments and walk in sessions. In April 2014 the GUM service integrated with the contraceptive service, providing a seamless service for patients across Oxfordshire. In addition to the hubs at Oxford and Banbury, nurse-led clinics are delivered from a number of additional satellite sites in the county.

The arrangement of services is as follows:

Churchill Hospital, Oxford

The main service, based at the Churchill Hospital, is open from Monday to Saturday. Patients are seen from 9.15am, with clinic closing at 6.30pm on Monday to Thursday and 4.30pm on Fridays. Routine booked and walk in clinics are run daily. The clinic on Saturday mornings runs from 0900 to 1300.

Orchard Health Centre, Banbury

There is a walk in service on Mondays, Wednesdays and Fridays and predominantly an appointment service on Tuesdays and Thursdays.

The outpatient services covered

Both sites offer a full service for the management of sexually transmitted infections including HIV infection, other genital conditions and all aspects of contraception. There are nurse-lead wart treatment and Hepatitis B immunisation clinics. In-patient facilities are provided by the relevant specialties, including Infectious Disease and Gynaecology.

Specialist clinics

Genital Skin Disease and complex GUM

Weekly clinic run by the speciality registrars; allows you to gain competencies in performing genital skin biopsies and hyfrecation, as well as managing the most complex GUM cases.

Vulval

There is a weekly clinic that reviews women with complex vulval skin conditions and vulval pain syndromes.

Psychosexual (including Erectile dysfunction)

There are 4 psychosexual medicine clinicsweekly.

Contraception

A full range of contraceptive services including implant and IUD/IUS fitting are provided. Trainees will be expected to obtain their DFSRH and participate in the delivery of contraception.

Prison

A weekly in reach genitourinary medicine clinic is provided to Bullingdon Prison, a male category B / C prison and a monthly in reach clinic is held in Huntercombe prison, a category C prison for men awaiting deportation.

HIV

The department has an increasing cohort of patients and provides regular care for approximately 350 patients. There are three dedicated HIV clinics held weekly, supported by a specialist pharmacist. Inpatient care is provided by the Infectious Disease service. There is a weekly MDT to review difficult cases and there are joint monthly meetings with Infectious Diseases, and routine Infectious Disease ward rounds on a Tuesdays and Friday mornings. The specialty registrar is responsible for liaising between the ward and the department in relation to shared patients. When there are Genitourinary Medicine or HIV in-patients specialty registrars are expected to visit regularly and contribute to management.

HIV In –patient care

Training in HIV in-patient care will be provided by regular attendance at the Infectious Disease Unit, liaising with Infectious Disease and GUM when GUM patients are admitted and during the rotation to Reading. The Reading Genitourinary Medicine department has responsibility for HIV in and out-patients and the in-patient experience is recognised for training purposes by the SAC in Genitourinary Medicine.There is the opportunity to spend time in London for more specialised HIV inpatient experience.

Medical Staff Members

ConsultantsDr L Dorrell (Honorary consultant)

Dr A Edwards

Dr R Malet

Dr H McShane (Honorary consultant)

Dr J Shefras (Contraception)

Dr J Sherrard

Associate Specialists1.8 Whole time equivalent

Specialty Doctors4.8 Whole time equivalent

Specialist Registrars3 Whole time equivalent (2 GUM and 1 SRH)

GP SpR1.0 wte

Slough

The Sexual Health Service in East Berkshire, known as the Garden Clinic, was formed in 1993 by the integration of the clinical services of Genitourinary Medicine, HIV and Reproductive healthcare. The philosophy of the service is to provide holistic sexual healthcare in one visit, on one site by one clinical team. Berkshire Healthcare Foundation Trust (BHFT) is the NHS provider. East Berkshire has a catchment population of 360,000, predominantly in the towns of Slough, Windsor, Maidenhead and Bracknell. The Garden Clinic in Slough is the central clinic, with satellite, locality clinics in Bracknell and Maidenhead

The Garden Clinic, Slough – this is a Level 3 service based in a community hospital, Upton Hospital, located in the town centre. The clinic has undergone a major extension and refurbishment to increase the number of clinic rooms and improve the reception, waiting room, and laboratory. The Service is supported by the Preview Clinical Management IT system and there is an active programme for developing an electronic patient record. A fully equipped in-house laboratory supports the investigation and management of STIs, with back up facilities provided by the laboratories at Wexham Park Hospital. This is a dispensing service, with on-site pharmacy support. The service has excellent relationships with General Practice and is a well-recognised centre for training in particular for reproductive health care.

It is a busy service, with some 20,000 annual attendances for STI care across the services, 12,000 attendances for contraception care and 4,000 attendances for HIV. The Garden Clinic offers a full service for the management of STIs including HIV infection, a full range of contraceptive services, sexual dysfunction and psychosexual problems. Integrated walk-in (WI) GUM and reproductive healthcare ie Sexual Health clinics run daily from 8.30 to 16.00. Specialist booked clinics run concurrently. Integrated walk-in services for young people run at all 3 Garden Clinic sites.

The Garden Clinic, Bracknell – provides Level 3 contraception and Level 2 STI services twice a week in a Health clinic in Bracknell town centre. This service is currently under review, with the aim of broadening its service delivery.

The Garden Clinic, Maidenhead – provides weekly Level 3 contraception and STI services in St Mark’s, a community hospital. This service is currently under review, with the aim of broadening its service delivery.

Heatherwood and Wexham Park Hospitals NHS Foundation Trust – Close links exist with colleagues in clinical and pathology disciplines in this DGH. This is the first-line in-patient facility for HIV-positive patients or GUM patients requiring admission.

HIV Care

The department has an expanding cohort of approximately 600 HIV-positive patients. Out-patient clinics run daily, with support from clinical nurse specialists, health advisers and a specialist HIV dietician. Virtual HIV clinics have been established for stable patients on antiretroviral therapy. In-patient care is provided by Heatherwood and Wexham Park Hospital (HWPH) in the first instance, with tertiary specialist support via St Mary’s or Chelsea & Westminster Hospitals. There is a weekly multidisciplinary team meeting with colleagues at HWPH to improve the care of HIV in-patients. Ante-natal HIV care has well established links with paediatric and O&G HWPH colleagues, with clear guidelines and patient pathways. A Family Clinic is run in conjunction with paediatricians from HWPH and St Mary’s at the Garden Clinic.

Enhanced Services

• Young persons walk-in, fully integrated GUM & FP service
• Psychosexual counselling service
• Chronic STI clinic – PEP, chronic HSV, HPV
• Specialist FP services – IUD / IUS / Implant insertions / Deep implant removal
• Nurse led GUM services – Wart treatment, Vaccinations, Symptomatic and asymptomatic STI screens
• Nurse led FP services
• HIV outpatient services (including specialist nurse adherence input, sexual health screening and reproductive healthcare)
• Family Clinic (HIV positive)
• Antenatal HIV care

As the Garden Clinic is an integrated service, trainees will have ample opportunity to obtain Reproductive healthcare training to DFSRH level & LOC in IUDs & Implants. There is a rolling education programme on Wednesday afternoons including external speakers, audit, case review etc

Timetable of Dr Clinics (WI=walk-in)

8.30 WI start / 16.00 WI close / 17.00-19.00
Mondays / (12.00-16.00)
Sexual Health WI / HIV
GUM specialist
FP specialist
Bracknell FP
Tuesdays / Sexual Health WI & booked
HIV / Sexual Health WI & booked
HIV
Wednesdays / Sexual Health WI & booked
FP specialist (2)
HIV
HIV Wardround / Education / Clinical Governance meetings
(13.30-16.00)
Young Persons walk-in clinic
Thursdays / Sexual Health WI & booked
HIV / HIV MDT
Sexual Health booked
HIV
Sexual dysfunction
Bracknell GUM/FP
Bracknell Young persons walk-in / (17.30-19.00)
Maidenhead
Young Persons walk-in
GUM/FP
Fridays / Sexual Health WI & booked
HIV / Sexual Health WI
Maidenhead

MEDICAL STAFF in the sexual health team

• Dr Mathew HamillConsultant in GUM/HIV (Clinical Lead)
• Dr Noreen DesmondConsultant in GUM/HIV (Educational Supervisor)
• Dr Stephen DawsonConsultant in GUM/HIV

• Dr Ritu VarmaConsultant in Reproductive healthcare
• Dr Clare ElliottAssociate Specialist in GUM
• Dr Nisha PalAssociate Specialist in GUM
• Dr Nina RadhakrishnanStaff Grade in Reproductive healthcare
• Dr Fresteh MazidiStaff Grade in Reproductive healthcare
• Clinical Assistants/hospital practitioners
• StR in GUM
• GP VTS

Close links have been established with many different specialities in the Acute Trust - medical, surgical, A&E, obstetrics & gynaecology, dermatology, pathology, urology and microbiology.

Reading

The Royal Berkshire Hospital is located in the centre of Reading. The population served is approximately 455,000. Reading is about 40 miles from London with ready access by road and rail.

The Department of Genitourinary Medicine is located in refurbished and spacious accommodation. This is a very busy department with some 40,000 GU outpatient attendances per annum. The clinic operates predominantly on a 7am-7pm walk-in basis but with appointment facilities for specialist clinics. Since April 2015, it has run a fully integrated GUM and Contraception service for young people aged 25 and under . Reading University has about 6,000 students of multicultural origin and therefore a full range of sexually transmitted and other conditions are seen in this clinic. Approximately 450 HIV positive patients regularly attend the clinic and the GU Physicians. We care for inpatients regularly (50-70 p.a.). We share inpatient care with the General Physicians and work closely with Microbiology; Intensive Care, Respiratory Medicine, Neurology and Radiology departments.

In addition to the core services the clinic also provides Contraception for people aged under 25, Complex contraception for all ages, Psychosexual Counselling, and special clinics for vulval and penile skin diseases.

The department actively supports research and audit activities and participates in

MRC studies (currently both START and AURAH site), virology/immunology studies (Cytotoxic T Lymphocyte Study with University of Oxford) and drug company trials (WAVES currently). There would be ample opportunities for trainees to design and carry out their own projects.

Additional educational/MDT type activities include:

1. Regular radiology meeting/teaching Consultant Radiologist
2. Regular TB MDT led by Dept of Respiratory Medicine
3. Joint Dermatology clinic with new Consultant Dermatologist (pending)
4. Weekly joint Hepatitis clinic with Dept of Gastroenterology
5. Weekly/case presentations and discussions (GUM and HIV)
6. Monthly jointly virtual metabolic clinic with Consultant Biochemist

Medical Staffing in Reading

• Dr Alan TangConsultant in GUM/HIV
• Dr Fabian ChenConsultant in GUM/HIV
• Dr Emma WainwrightConsultant in GUM/HIV
• Dr Gillian WildmanAssociate Specialist in GUM/HIV
• Dr Caroline RimmerAssociate Specialist in GUM/Contraception
• Dr Judy FeltonAssociate Specialist in Contraception
• Dr Tanyi AyukonchongSpecialty Doctor
• Dr Ruth ReakesSpecialty Doctor
• Dr MittalSpecialty Doctor
• Vacant postSTR in GUM
• Mrs Janice BurnettNurse Consultant in Sexual Health

Duties of the Post, Teaching and Research

Generic information, daily commitments will vary according to centre.

a)Principal Responsibilities:

You will be expected to staff routine Genitourinary Medicine clinics both at the base hospitals and in satellite centres. As training progresses you will also take part in referral clinics, in particular the HIV outpatient clinics. There will also be administrative commitments determined by the level of experience.

b)Daily Commitment:

Routine GUM clinics may run from 7am to 7pm, with variations between centres and days of the week. The appointee will staff on average the equivalent of 6-8 sessions (24-32 hours) per week, as intended in the training programme. These will be flexibly worked and will include late sessions each week (usually completed by 6.30 to 7 pm) as well as sessions in satellite services. The appointee will also staff one HIV clinic each weekand monitor progress with inpatients daily.

c)Description of Working Pattern

The main commitment will be to the routine Genitourinary Medicine service where excellent supervised experience in all aspects of Genitourinary Medicine can be gained. The clinics offer a daily choice of walk in services and appointments.

Specialty Registrars (StRs) are expected to arrange their working day flexibly so that the time worked fits within their contracted hours. This means that they must ensure availability for core clinical commitments but that start and finish times can be arranged flexibly, with the rota co-ordinator, so as to fit with a 40 hour working week. The specialty registrar will have responsibility for advising on the management of emergency Genitourinary Medicine including HIV problems presenting through other services such as Accident and Emergency and Gynaecology or directly referred by general practitioners during clinic hours. There are currently no on-call commitments in GUM or general medicine.

Training and Research

d)Teaching

The post-holder will play an active part in local and regional seminars, journal club, grand round presentations and training sessions for medical students, visiting doctors, other medical staff and allied health professionals. On the Oxford years of the rotation, trainees are responsible for organising the medical student 5th year attachment in Genitourinary Medicine and for supervising students who select the Special Study Module in the 6th year. They are also expected to facilitate on the formal teaching and assessment sessions for medical students. The trust offers formal training to enable registrars to regularly examine students in the GUM station of their OSCE.